Healthcare Provider Details

I. General information

NPI: 1679230312
Provider Name (Legal Business Name): JILLIAN MOEHLE ND
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/17/2021
Last Update Date: 11/17/2021
Certification Date: 11/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 E JEFFERSON ST STE 603
SEATTLE WA
98122-5649
US

IV. Provider business mailing address

219 27TH AVE E
SEATTLE WA
98112-5426
US

V. Phone/Fax

Practice location:
  • Phone: 206-726-0034
  • Fax:
Mailing address:
  • Phone: 564-205-0720
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: